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題名 | Surgical Treatment of Recurrent Groin Hernia=復發性鼠蹊部疝氣的外科治療 |
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作者 | 黃清水; | 書刊名 | 臺灣醫學會雜誌 |
卷期 | 98:2 1999.02[民88.02] |
頁次 | 頁122-127 |
分類號 | 416.2423 |
關鍵詞 | 復發性鼠蹊部疝氣; 外科治療; Recurrent groin hernia; Giant prosthetic reinforcement of the visceral sac; Preperitoneal prosthetic mesh; Shouldice repair; Stoppa operation; |
語文 | 英文(English) |
英文摘要 | Recurrent groin hernia is not uncommon in Taiwan. Subsequent surgical repairs are difficult, due to cicartrization and deterioration of the inguinal floor. In this report, the intermediated and long-term outcomes of 212 patients with recurrent groin hernias who underwent surgical repair within a 10-year period were analyzed in order to assess the effectiveness of two modified repair techniques. Patients with unilateral first-time recurrent hernia (UR; n=87) were treated by a modified Shouldice technique using an inguinal approach. Those with bilateral or multiple recurrences (MRs;n=125) were treated with giant prosthetic reinforcement of the visceral sac (GPRVS, Stoppa operation) using a midline preperitoneal approach. Complete exploration of the groin floor on the side of recurrence revealed a high rate of direct space defects (UR,41.5%;MR,65%) and multiple posterior wall defects (UR,29.9%; MR,30%). In the UR group, a 4 x 10-cm preperitoneal prosthetic mesh was incorporated to reinforce the repair. For MR patients, I reduced the transverse dimension of the mesh prosthesis by 2 cm compared with the original Stoppa protocol; to reduce crinkling, the average dimensions were 23 x 14 cm. Complications in the UR group included testicular atrophy (3 patients) and femoral vein thrombosis (1). Complications in the MR group were transient scrotal fluid accumulation (9 patients) , fatal perioperative acute myocardial infarction (1), and failure of the peritoneum to grow over the mesh (1). The average hospital stay was 3 days in the UR group and 6 days in the MR group. The long-term follow-up (1-9 years) revealed a 5.7% re-recurrence rate with an 86.2% follow-up rate in the UR group, and a 1.9% re-recurrence rate with an 86.6% follow-up rate in the MR group. I conclude that GPRVS is an excellent treatment for URs, but the transverse dimension of the prosthetic mesh should be reduced for Taiwanese subjects. However, for first-time MRs, a modified Shouldice technique with incorporation of a preperitoneal prosthetic mesh is still recommended. The surgical dissection is less extensive and the hospital stay is shorter, while the re-recurrence rate is acceptably low. |
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